Provider Demographics
NPI:1952496010
Name:COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY
Entity Type:Organization
Organization Name:COUNTY OF RIVERSIDE-COMMUNITY HEALTH AGENCY
Other - Org Name:PUBLIC HEALTH LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:WON-CHEN
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-358-5070
Mailing Address - Street 1:PO BOX 7600
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-7600
Mailing Address - Country:US
Mailing Address - Phone:951-358-5070
Mailing Address - Fax:951-358-5015
Practice Address - Street 1:4065 COUNTY CIRCLE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3410
Practice Address - Country:US
Practice Address - Phone:951-358-5070
Practice Address - Fax:951-358-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1158 PUBLIC HEALTH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB71882FMedicaid
CA05D0571882OtherCLIA #